Albumin-bilirubin score as a practical tool for prognostication in metabolic-associated steatotic liver disease

Table 1 Key noninvasive prognostic markers in metabolic dysfunction-associated steatotic liver disease

Marker	Core components	Main domain assessed	Data type	Major strengths	Major limitations
FIB-4	Age, AST, ALT, platelet count	Structural (fibrosis burden)	Biochemical	Simple, widely validated; good negative predictive value	Influenced by age and inflammation; limited sensitivity for advanced fibrosis
NFS	Age, BMI, diabetes, AST/ALT ratio, platelet count, albumin	Structural + metabolic	Clinical + biochemical	Incorporates metabolic risk; widely used	Requires multiple variables; moderate specificity
ELF	Hyaluronic acid, PIIINP, TIMP-1	Structural (fibrogenesis activity)	Serum biomarkers	High diagnostic accuracy; validated vs histology	Requires specialized assays; costly
ALBI score	Albumin, bilirubin	Functional (hepatic reserve)	Biochemical	Objective, continuous, easily automated; complements fibrosis indices	Not validated in acute liver injury; limited data in early MASLD

FIB-4: Fibrosis-4; NFS: Nonalcoholic fatty liver disease fibrosis score; ELF: Enhanced liver fibrosis; ALBI: Albumin-bilirubin; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; BMI: Body mass index; PIIINP: Amino-terminal propeptide of type III procollagen; TIMP-1: Tissue inhibitor of metalloproteinases-1; MASLD: Metabolic dysfunction-associated steatotic liver disease.